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Submaximal adenosine‐induced coronary hyperaemia with 12 h caffeine abstinence: implications for clinical adenosine perfusion imaging tests
Author(s) -
Carlsson Marcus,
Jögi Jonas,
Markenroth Bloch Karin,
Hedén Bo,
Ekelund Ulf,
Ståhlberg Freddy,
Arheden Håkan
Publication year - 2015
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/cpf.12125
Subject(s) - medicine , caffeine , abstinence , hyperaemia , adenosine , myocardial perfusion imaging , perfusion , cardiology , coronary flow reserve , anesthesia , coronary artery disease , blood flow , psychiatry
Summary Background Adenosine is widely used as a vasodilator agent in myocardial perfusion imaging. Caffeine inhibits the effect, but the time of caffeine abstinence needed is under discussion and varies from 12 to 24 h. Therefore, our aim was to examine whether the time of caffeine abstinence affects the hyperaemic response using quantification of coronary sinus flow ( C S F ) with cardiac magnetic resonance ( CMR ) during adenosine infusion. Methods Healthy individuals ( n = 16, eight females, age 41 ± 3 years) underwent two CMR examinations with 12 and 24 h of caffeine abstinence. C S F was quantified with phase‐contrast velocity mapping ( PC ‐) CMR during adenosine infusion (140 μg kg −1 min −1 ) and rest and the C S F reserve between adenosine and rest was calculated. Myocardial perfusion ( MP ) was calculated as C S F × heart rate/left ventricular mass. Cardiac output ( CO ) was quantified using PC ‐ CMR of the ascending aorta. Results The C S F reserve was lower after 12 h abstinence compared to 24 h (4·31 ± 0·57 versus 5·32 ± 0·76, P = 0·03). In six of 16 subjects (38%), C S F reserve was >30% higher with longer caffeine abstinence. MP during adenosine was lower after 12 h compared to 24 h caffeine abstinence (3·59 ± 0·37 versus 4·23 ± 0·28 ml min −1 g −1 ; P = 0·046). The increase in CO during adenosine between the two occasions did not differ (55 ± 7% and 55 ± 6%, P = 0·11). Interobserver variability for C S F /heartbeat was −0·05 ± 1·00 ml. Conclusions Hyperaemia during adenosine is lower in some patients with 12 h of caffeine abstinence compared to 24 h. Longer caffeine abstinence, that is 24 h, is of value before pharmacological stress testing as the individual response is not known and the individual variation is large.